Month: August 2019

Combatting Burnout; Life vs. Workload

Twenty-four hours after posting about my personal experience with burnout my blog traffic went up 850%. 850% y’all. This is validating and maddening. And no one is doing anything about it. The people that notice what’s going on host seminars and tell people to do more yoga. We need more than that. Can you imagine if Google ran healthcare? After every code blue we’d all probably get two weeks at a yoga retreat. (Can I get an ‘Ohm’men?)

After seeing the increased traffic, I immediately felt on the hook. I shared my thoughts on burnout and felt like it was necessary I share ideas on how to move away from the scary side and more towards the joy side of the burnout spectrum. I came up with 9 different ways to move things towards the side of joy. (The recovering perfectionist in me is hating that it’s not an even 10.) But then I realized I didn’t really explain the symptoms of burnout either. Keep reading.

Nursechoice.com describes being on the “brink” of burnout as experiencing the following:

Apathy (lack of emotion): It’s scary sometimes how talking about something like seeing a dead body evokes no emotion. We have dissociated ourselves as a defense mechanism – a normal response to trauma – but this is not where we want to be with our humanity. Showing emotion is not weakness. It takes courage and vulnerability to not armor up and let ourselves feel and be seen. I could go on and on about Brene Brown’s research and what it means to be real with people. I’ll let you have that journey.

Recently I heard a story about a local nurse shaming another nurse for crying when her patient was dying. Are you kidding me? I get to cry because that’s incredibly sad. Does any of this sound familiar to those coming back from combat with PTSD?

Depersonalization (they’re things, not people): This is very easy to slip into in the operating room. The person on the table, lying there unconscious and naked, and we are all oblivious to this- it might as well be a tree trunk we are operating on.

Sleep Disturbances: Oh my gosh this made me laugh. Between getting calls in the middle of the night to do a case, to waking up at 2am realizing I forgot to chart the patient’s tube feed, to my body aching so that I can’t sleep, to hearing the monitor’s alarms in my nightmares – This one was just funny to me.

Short tempered: We have no patience because patience takes energy. No energy, no patience.

Physical disorders: I don’t know if they mean disorders from chronic flight-or-flight stress and cortisol pumping through our veins – or the cancer we give ourselves from the diabetic doughnuts, radiation exposure, and processed food we eat.

I’ve come up with some things that I feel like would help us combat burnout that is within our own control. I’ll be honest I got a little overwhelmed reading it all- maybe pick one thing a week to work on. Start small and give yourself grace along the way.

“God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Decrease the Workload

This all about balance and one way to tip the scales towards the ‘joy side’ is to decrease your workload. That looks different for everyone. For some, it means taking that break that is offered to you. Some people are saying “duh,” but you’d be surprised at how many people pass on the breaks when they are either offered or available. Either they are “too busy” or “they won’t do it like you can” or they don’t want to be bothersome or needy.

“Putting other people ahead of yourself is poison disguised as nobility.”

One more time for the people in the back (say it out loud to yourself): Putting other people ahead of yourself is poison disguised as nobility. There is a reason why the flight attendants tell you to put your oxygen mask on first. Your everyday work life is not a matter of life and death for everyone, only the people you are caring for. Yes, if I had to make a choice between saving my life and a child’s I hope that in that moment I could choose to save them and sacrifice myself. But that’s not what we are doing here every day at work. You cannot, CANNOT, care for people if you haven’t cared for yourself first. Get that thought out of your head that self care is selfish- it’s not. If you are tired, lack energy, your emotional cup is empty- you will not be able to have empathy. That is the reason of why we went into healthcare (or insert your career), right? Because we see a need and we want to fulfill it. But the only way you can really do that is by taking care of your needs first. It is not selfish to do so, it’s necessary.

So while at work- take the break. I’m not calling for people to become lazy. I’m saying to take those breaks when you can. You’ve trained your body to ignore the cues (aching joints, dry mouth, brain fog). Since we won’t notice them we need to take care of them on a regular basis. Drink the water. Put your phone down and just close your eyes for 10 minutes and meditate, go to your car if you can.

If you are able to financially, start cutting back your schedule and hours you work, even if it’s a little at a time. Start saying no to work projects. If they don’t have the staff to get the work done- that is their problem, not yours. If everyone was able to only give what they can give and not over-extend themselves, and the company is not getting what it needs done- then they need to hire more workers. We cannot keep extending our humans to the breaking point. That’s not ok. If you are in management and you are the one being squeezed, it will take an extra amount of energy to have firm boundaries.

Let’s say you are in charge of keeping a group staffed and production at a certain pace. If you have firm boundaries and don’t push your staff to the end of the burnout spectrum, things are going to start to go wrong. You have to expect that production is going to go down and your superiors are going to start questioning things. It has to start hurting for things to change in some facilities. Some have to see numbers drop before they are willing to do anything. What you tolerate is what will continue. But even so, if they see you as unwilling to do what they want and you get fired- I pray for God’s direction, guidance, and redemption for your life. When you stand up for injustice, God takes over and goes before you to make your paths strait. Be brave. Because, personally, I don’t want to go down with that sinking ship. I don’t want to be a part of an organization that treats their workers like robots. Bye Falicia.

2. Increase the Life

Again, increasing the “life” side of the equation looks different for everyone. Maybe it means scheduling vacation every so many weeks. Or getting regular massages, pedicures, scheduling a night out with a friend. (Hint: scheduling is soo soo important. If it takes up time, it gets on the calendar. For me, my Fridays are sacred. I do not schedule anything work related on Fridays. Those days are for me to do whatever I want. Do the fun thing.

When I was a kid my mom knew the look on my face as soon as I would wake up – usually once or twice a semester. She would say , “let’s take a mental health day.” And she and I would skip work and school and get bagels and go to the zoo. I had no idea what mental health was or why we were celebrating it but I am so grateful for her example. I’m sure she needed it just as much as I did but it definitely refueled me to make it through the season. Eat the bagel. Go to the zoo.

3. Find a Creative Outlet

We are creative beings. If you’re one of those people who say “I’m not creative,” stop saying that. Unless you don’t want to be creative -because you can literally convince your brain of anything – positive and negative. I read the book Called to Create by Jordan Raynor and it motivated me to take the photography classes I’ve always been wanting to do. The thing about being creative is it is vulnerable. It’s part of our humanity. If you are a good nurse and let perfection do the driving, shame is riding shot gun. You’ll never be perfect; therefore, you’ll always be dealing with shame. (Cue Brene Brown quotes). “There is no innovation and creativity without failure.” You’re gonna make some weird stuff. And it’s gonna feel vulnerable to failure, disappointment, a ridicule. But eventually you’re going to find that thing that sparks you. That makes you forget to pee -in a good way. That passion that fuels you and brings you to life. Whatever it is, find it. Who knows, maybe it will be another career path for you. Look at what you create and be proud. Hang it on the wall. Remember it is a piece of you and you were brave enough to create it. We were created in God’s image and he was the most creative of all of us.

“Whenever we bring order out of chaos, whenever we draw out creative potential, whenever we elaborate and unfold creation beyond where it was when we found it, we are following God’s pattern of creative cultural development.” – Tim Keller.

4. Take the Vacation

I am amazed at the number of millennials with no job willing to pack a backpack and a head to wherever with a friend a document it. They become “influencers” and make money for traveling with no money. I am truly jealous of their stories and life experiences. If I had to guts to do that when I was twenty I would be in South America right now blogging about my favorite sandals to wear in Bali while riding an Elephant. They’d be locally sourced made from recycled peanuts.

My point is, there’s something to be said for travel – and it can be done on a budget.

“Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime.” – Mark Twain.

5. Love Yourself

This should be number one- because it’s the only way any of this is going to work. I haven’t figured out a trend as to why, but I get the feeling a lot of nurses do not find themselves worthy of love and belonging and kill themselves trying to can earn it.

You. Are. Worthy.

You are worth it. You are worth caring for. You are worth loving. You are worth saying no for. You are worthy of a break, a vacation, a hug, a cry, a complement. You are worth it all because you are a child of God. Don’t believe it if you were to say it to yourself? Chart a new path in your brain. Our brains a plastic and moldable. Write it on 75 post it notes and say it out loud 947 times a day until it starts to feel real. You can even use progressive affirmations like “I’m figuring out what it looks like to feel worthy.” Or “I’m on my way…” Affirmations help cultivate the self love we need so badly. Here is my blog on what God thinks of you. And to go a step further, when you say an affirmation and pair it with the scent of an essential oil, its physical properties enter your brain directly to the limbic system, bypassing the processing center. You are “pavolving” into loving yourself.

6. Take Care of Your Body

Put the pop (yes I say pop) down. Drink the water. Go for a walk. Join a gym. And in the words of Rachel Hollis: “eat the stupid salad.” Your body can’t function on processed food. Give it vitamins and nutrients. It’s trying so hard to constantly detoxify and heal. So thank it and give it some support.

7. Get Emotional Support

This means a whole lot of things. Bring your tribe in closer. Take time with friends and family or a counselor- someone who can give you empathy. This is so important to take care of our emotional wellbeing. Remember the end of the burnout spectrum is suicide or drug use. It’s normal and natural to numb pain. There’s nothing “wrong with you” if you’re crying on the way to work, praying to get stuck in the elevator to avoid work, or wondering what it would be like if you didn’t turn the wheel and went off that cliff. It means you need help. If you are at that point you need drastic change- and quickly. Talk to your people. If you don’t have people, find some people at church, or a counselor. This is serious.

Support can also look like paying for services like Amazon or Shipt grocery delivery, and fast food delivery. I pay an annual fee to have my groceries delivered- it is worth every penny to save me an hour every week (or more) going to the store. Is 52 hours of time worth $50? You bet. (Want to try Shipt Grocery Delivery? Here’s my code for $50 off: mHT8M). Sometimes I’m working while they are shopping. And other times I am literally laying on the couch reading or scrolling Instagram and I feel not one ounce of guilt for it because that is what I need in the moment.

Start saying no. I am not naturally tactful. I am a recovering people-pleasing doormat. (See what I did there- I’m not identifying with something I don’t want to be so I’m ‘in recovery’ or ‘figuring out what it looks like to____’). My go-to phrase for saying no is with kindness and grace. Something like “thank you so much for the invite but I’m going to have to pass.” Or “I won’t be able to make it” and not explain why or give an excuse. It keeps me from lying. Lying feels yucky and I try to be as trustworthy as I can. I always say “thank you for thinking of me but at this time I can’t commit” to whatever it is. Amy Smith goes into immense detail in her Podcast, the Joy Junkie, and how to perfect the “no.” It’s amazing how liberating it is to gain back your power.

There’s also laundry services, asking your spouse to pick up a few responsibilities, delegating to other family members, paying for a lawn service or nanny. Or what about moving? Downsizing to a more minimal lifestyle will do wonders for mental health as well as your pocket. Sell some junk so you can take a day off. Have a garage sale, donate to charity instead of buying Christmas gifts, or move to a smaller house. Have you heard that saying “more money more problems?” You don’t need that over time paycheck as much as you need to start living your short and precious life. You only get so many sunrises with coffee. It’s time to start living.

8. Give Your Time and Money.

This is going to sound absolutely counterintuitive because I’ve been talking about working less, having less money, and spending money on yourself and vacations. But there’s something that happens when you give with a cheerful heart. One year I bought 10 QuickTrip gift cards and wrote on the back a few affirmations. I kept them in my car and gave them to the people with signs on the street corner. It gave me so much joy that I would look forward to stopping by them. Or volunteer at a local homeless shelter. No matter how much I encounter the less fortunate at my job, I’m still humbled at hearing their stories.

9. Practice Gratitude

Brene Brown, with whom I clearly have a woman crush as much as I talk about her, researches shame and vulnerability and has written books sharing her findings. She has found in her research the key to joy is GRATITUDE. For my research nerds -there is a direct correlation between the amount of gratitude one observes and the amount of joy they experience. Don’t spend your money on an app or a fancy notebook, just stop and look around and thank God for your socks, your air conditioning, the fact that you don’t have dirt for floors (there is a tech I used to work with who had dirt floors- in America people.). This kind of goes with number 8 – the more you give to those less fortunate, the more you spend time with them, the more you share your blessings with them, the more you are grateful for your own situation – the more joy you will have.

And I am grateful for you.

Shameless plug: If you want to know more about using essential oils to combat fatigue, help your thyroid, use with prayer and meditation, anxiety and panic support, or CBD send me a message. I’d love to connect and give you more tools.

I think I’m finally ready to share this. I wrote it over a year ago. As the status does not change I become more and more passionate about it.

There is an illness infiltrating the medical field that many are not aware of. Only this illness is not infecting the patients, its affecting the doctors, nurses, and other healthcare personnel. It’s insidious and most don’t even realize it’s taking place in their lives.

Burnout

There are predictable symptoms and progression, just like a disease process. Statistics say almost half of physicians had a least one symptom of burnout and only 54% would choose medicine again as career path. – We are regretting going into healthcare.

One end of the burnout spectrum is joy and on the other end is suicide and drug use. It’s predictable, it’s linear, and it’s killing the people behind the number one industry in America.

It’s an imbalance of life vs. workload. The less demanding your job is, the less amount of time you need to fill your “cup”. This “cup” is our most precious asset (besides time)- our energy. Our energy is what makes us human. It gives us life. When we don’t have energy, we can’t smile, can’t laugh, can’t have empathy, can’t care for others or ourselves. We lose our humanity and become zombies.

Let’s say you get paid to take photos of nature- I picture this person as a care-free, low stress, creative soul. They leave for work when they want to- or maybe they get the thrill of capturing that sunset but it’s worth it for them to be out after dark. They look at their work with pride and crack open a beer and laugh with their friends. Their imaginary work life is what I want when I grow up. They don’t need much time to fill their “cup” because it’s also being filled why they work.

But the more on-the-job stress that is added, more time is required to fill your “cup”. So the ER nurse who is running her butt off, fueled by a heart-attack-inducing energy drink and adrenaline, is saving people- one after the other. Her non-work life probably requires a lot of physical rest to give her adrenal glands a reset, a creative outlet, and help doing every day chores. Someone to help with laundry and dishes and cooking. Because if she spends all of her free time trying to keep up with every day living- her “cup” never gets refilled. She goes back to the ER to do 14 hour shifts where she doesn’t get to sit down, she gets 10 minutes to shove a doughnut in her mouth at midnight, and water (?) – she will just apologize to her kidneys and pray they hang in there until the fourth day when she will actually get the chance to drink. If you’re in the medical field you are probably shaking your head in agreement at this point. If you are in the corporate world where you get an hour for lunch, you get to take off to get your kid from school, you get to go to a doctor’s appointment, you get to call in sick, or you get to drink and pee whenever you want; consider yourself informed of what is actually going on behind the scenes of healthcare. Basic human needs are ignored here. It’s like stepping into a third world country.

Where I live there is still an underlying assumption that the woman takes care of the household and the children while the man is out making money to support his family. But since women started working outside the home during the war- we have discovered we can be successful workers too. I won’t go into my personal experiences of making less than my male peer for doing the exact same thing- dare I say better because I’m hard wired as a woman to pay attention to detail. This is not about men vs women because we are made to have our own set of strengths, complimented by the others weaknesses. But we have to bring to light the 1950’s culture that is still going on in the workplace.

In 2009, 19% of surgeons were women. In 2015, 19% of surgeons were women(1). (I’m focusing on the operating room because that is my personal experience- I acknowledge not all healthcare environments are this culture). Ninety-one percent of nurses are female (2). So by default, in my facility, we have a 1950’s model of the Panam situation in Catch Me If You Can where the men are flying the plane and the women are the servers.

I could do a whole blog post on the types of women that go into nursing and their personalities. It’s my impression that a lot of nurses want so badly to be perfect, to care for, to serve, to sacrifice for, and to please -at all costs- their physicians and patients. It can take a tremendous amount of energy for some nurses to stand up against injustice because of this ‘aim to please’ mentality. So these women are in a culture to serve and please (mostly) men. Healthcare is constantly changing and becoming more demanding for these employees and they are still being asked to do the laundry and the cooking and cleaning at home. They never get time to recharge. A lot of households are moving away from this trend but I still see it where I live. And what about single parents?

But I won’t forget the surgeons – they are being exploited too. They are no longer running their own practices- they are owned by the hospital. They are being pressured to bring in certain amounts of revenue. When you do the math and see the numbers (or else they will be replaced by the next eager surgeon on the assembly line) they have to work all day, operate on anyone they can, and take call all the time. They never get a chance to recharge. They work from 7:00am to 8:00pm and get calls in the middle of the night. They come in on Saturdays to do non-emergent cases because they can’t get to them during the week. They are hiring PA’s to follow up with their patients because they don’t have the time to see their patients themselves. And bringing their nurses and scrub techs along with them into the late nights and weekends.

There are so many things driving this increased demand on our healthcare workers. I’m not interested in those politics or statistics. I’m interested in the microcosm view of what is around me and what I see. I see tired nurses and techs and surgeons. They are burned out. They have no voice. They feel stuck. They can’t afford to call in and leave their already critically understaffed co-workers to die a slow death, picking up their workload. Financially they are strained and can’t afford a sabbatical. They are being pressured to be perfect and keep up efficiency at work to keep the surgeons and administration happy with their numbers. They are stressed out making their patients happy and provide empathy while being a an over-worked zombie. Heaven forbid they make a human mistake during all of this, they’ll be verbally abused for it. They have no time to work on themselves or grow in personal development because they are operating in survival mode all the time.

I’ve experienced burnout for years, myself. I found that I was surrounded by hateful and unhappy people; doctors, nurses, patients, ancillary staff. “Thank you’s” and “great job” were a rare gift. No one wanted to be there and a lot were struggling at being a human. I began to feel like my soul slowly was degrading, dying a slow death. My morals and values were slipping. I was working holidays and suppressing the guilt that I traded money for irreplaceable family joy and memories. I was overeating just to get enough endorphins to get me through my shift. I was lonely because none of my family understood how I felt. I was cynical. It almost didn’t matter what I did because I felt like most things were out of my control. I was being emotionally abused by my coworkers and physicians. My boundaries were no more. It was “normal” to be yelled at by so-and-so ‘that’s just how he is.’

I was trapped in a job I didn’t enjoy anymore in order to make the money to support the life style I had become accustomed to. We were so desperately in need of workers that I was unable to take a day off without a years notice. Sick and vomiting? Go to work, they’ll give you an IV. Didn’t sleep on your call shift? Work 24 hours post call since it’s double the pay. Going through a divorce and need a mental health day? Hah, that is laughable.

Hospitals are overworking, underpaying, and under supplying their employees. In the past we’ve had supplies and medications -that would add to patient comfort -taken away just simply due to cost. Everything needed to be faster to increase volume and revenue. There was always a person over my shoulder snapping their fingers.

I found myself exhausted even after an 8 hour shift. I decreased my hours from 65 to 40 per week. I worked less and had normal daytime hours, but why was I so tired? I had little emotional energy to give my family after I’d come home and take a power nap. Was there something wrong with me? I was depressed and unhappy despite having checked off all the boxes: well paying career, a family, dream house, nice car.

I attended a mandatory seminar where the phrase “burnout” was referred to as one of the many cause of poor communication in healthcare. I went to my car after it was over and just broke down and cried. I was burned out. I quickly did a google search to confirm my suspicion. I was horrified to read the next level on the progression of symptoms was drugs, alcohol, and suicide. Being female with access to controlled medications I was at a very high risk.

How did I get here? How did this happen? Every day I went to work I hit the ground running- going as fast as I humanly can to keep up with the usual pace. I was holding my body in a constant state of fight or flight to keep vigilance in case someone tried to die. My adrenal glands were trying to keep up with my sympathetic nervous system’s requirements. Not to mention, everything I did was not motivated out of goodwill towards the patient. I was doing and charting out of fear of how my actions would be judged in the case of a malpractice law suit. I liken every day to that caveman who has no tribe (everyone for themselves). You’re being sent out to defend for yourself against all the beasts of the world (lawyers, job security, mean doctors, unhappy patients). You keep your sympathetic nervous system in constant state of fear and it’s exhausting you to the point of giving up on life. That is the best way I can describe burnout.

I’ve managed to figure out a way to keep myself on the burnout scale closer to the “joy” end by cutting back significantly on my hours. I’ve taken up a creative hobby and side job. I’ve invested financially into passions of mine. I’m praying every day that one of them takes off so I can leave my Masters Degree and healthcare altogether. That may never happen but in the mean time I don’t lose hope.

There is no grace in medicine. Our administrators have turned their gaze from us to the dollar signs. People have forgotten healthcare workers are not robots- we are humans and we are trying the best we can with the information and supplies we have and we are dying a slow death because of it. Someone send help.

Disclaimer: I am not a researcher. While I did my fair share of Masters thesis reference pages – I do not care about format. I’m just concerned about giving credit where I find my statistics. I’m not consumed with spending a large amount of time finding accurate and recent data – that’s not the point of this opinion blog post.

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